Posts Tagged iPad

SINGAPORE – It is a Friday afternoon and Mr Chin Tian Loke, 72, is watching a video on an iPad Air in his five-room flat in Jurong West. He mimics the movements of the person on screen, lifting his arm, which has a sensor attached to it at a 90-degree angle. A voice from the iPad then congratulates him: “Spectacular!”

It appears as though Mr Chin, a retired odd-job worker, is playing a game. But he is actually undergoing rehabilitation therapy, to help him gain strength in his limbs after he fell and broke his spinal tail bone in November last year.

Mr Chin is one of the first to try out a novel healthcare system, announced on Friday (May 5) by healthcare technology agency Integrated Health Information Systems (IHiS).

The system aims to make physiotherapy as painless as possible: by allowing patients to exercise at any time of the day, within the comfort of their own homes. This removes the need for a patient to commute to and from a rehabilitation centre and hopefully, boost participation rates in attendance for rehabilitative therapy, which would then prevent the chances of re-admission to hospital. As National University of Singapore’s Associate Professor Gerald Koh, who pioneered the system, noted: “Often, the reason why a patient needs therapy is the reason why the patient finds it hard to go for therapy.”

The solution is technology.

All that is required is an iPad and two sets of sensors – which will be loaned to the patient by the healthcare institution – and an open mind.

Believed to be the first of its kind,Smart Health TeleRehab, as the system is known, will enable Mr Chin’s physiotherapist from Touch Home Care to keep tabs on his exercise regime remotely. Each exercise session will be automatically recorded and saved to a digital cloud, which his therapist views within two working days.

If a patient has completed the prescribed exercises successfully, the physiotherapist can increase the difficulty of the exercises at the touch of a button. If not, she will call Mr Chin to guide him on the right way to do the exercises. If further explanation is required, the physiotherapist will pay him a home visit within the week.

Smart Health TeleRehab is currently being used by 11 patients at two healthcare providers – Touch Home Care and NTUC Health. But 12 more -including Changi General Hospital, Khoo Teck Puat Hospital, and SPD (formerly known as the Society for the Physically Disabled) – will come on board by the end of this year (2017), as Singapore ramps up programmes in line with its Smart Nation ambition.

An estimated 1,000 patients are expected to benefit from the pilot programme by the end of next year (2018). IHiS’ latest initiative follows its April roll-out of a video call system for medical consultations to six public healthcare institutions that enables patients to consult experts from the comfort of their homes.

Mr Chee Hong Tat, Senior Minister of State for Health, visited Mr Chin on Friday at his home to see how the Smart Health TeleRehab system could be deployed. He said: “Smart Health TeleRehab could transform how therapy services are delivered in Singapore. Patients will benefit from greater convenience, cost savings and better outcomes. Therapists and therapy service providers will also benefit from the productivity improvements.”

The cost of Smart Health TeleRehab sessions depends on the various healthcare institutions, and the subsidies that a patient qualifies for.

As a gauge, at Ang Mo Kio Thye Hua Kwan Hospital, which will run the programme from next month (June 2017), a patient can expect to pay between $3 and $50 for one Smart Health TeleRehab session. In comparison, a patient has to pay more than $80 for one treatment session at the centre (excluding transportation costs, which could go up to $75 per way), or more than $160 for a therapist to visit him at home.

Singapore’s therapists too, will benefit from productivity gains. In 2016, there were about 2,570 occupational and physiotherapists here. However, figures from the Health Ministry show that 53,000 patients had to undergo physiotherapy in 2014 – and the health authorities are only expecting this number to grow over the years as the population ages.

An initial study led by Prof Koh found that the system could help therapists reap productivity gains of more than 30 per cent. A telerehab session, on average, takes about 52 minutes. A therapy session conducted in the patient’s home, however, could stretch up to almost 80 minutes. So in the time that a therapist usually takes to see three patients the conventional way, the therapist can see four patients instead via the TeleRehab method.

Smart Health TeleRehab may not be suitable for all patients, such as those who have diabetes or other complications.But with more patients on the technological platform, it frees up therapists so they can have more face-time with more needy patients.

Singapore Management University’s (SMU) School of Information Systems’ Associate Professor Tan Hwee Pink volunteers with the Stroke Support Station (Singapore) and has an elderly father recovering from a complex hip fracture after a road accident last year. He welcomed the new platform as a timely one.

Despite the benefits, however, he pointed out that most patients recovering from an accident or stroke would have weakened mental strength. “This needs to be addressed for the patient to be motivated to do the rehab at home. As we know, patients tend to do what they are told in a controlled environment, but not necessarily so when they are in the home environment,” he added.

One possible way to do this is to allow more functions to be used on the iPads, such as watching TV or making calls, for example, he suggested.

Professor Atreyi Kankanhalli, from the department of information systems at the National University of Singapore’s School of Computing, said the TeleRehab method also give patients a greater sense of autonomy and control, as they can do the rehabilitation exercises on their own. She added: “With the increasing incidence of chronic diseases, shortage of healthcare professionals, and yet the availability of more intelligent technologies, healthcare is a prime sector that can benefit from Smart Nation initiatives – in addition to other key sectors such as transport, commerce, utilities, security and education.”

Abstract

Introduction

Successful recovery of upper extremity function after stroke is more likely when the affected limb is used regularly in daily life. We developed an iPad (Apple) application called the ‘Aid for Decision-Making in Occupation Choice for Hand’ to facilitate daily upper extremity use. This study examined the suitability of items and pictures in the Aid for Decision-Making in Occupation Choice for Hand, and tested a paper prototype of the application (which has since been produced).

Method

We used a Delphi method with 10 expert occupational therapists to refine the items in the aid. Next, we prepared pictures of items in the aid and confirmed their suitability by testing them with 10 patients (seven stroke, three cervical spondylotic myelopathy). Nine occupational therapists conducted field tests with a paper prototype of the aid in clinical practice to examine its utility.

Results

After four Delphi rounds, we selected 130 items representing activities of daily living, organized into 16 categories. Of 130 pictures, 128 were recognizable to patients as representing the intended activities. Based on testing of the paper prototype, we found the Aid for Decision-Making in Occupation Choice for Hand process was suitable for clinical practice, and could be organized into six steps.

Conclusion

The Aid for Decision-Making in Occupation Choice for Hand process may promote daily upper extremity use. This application, since developed, now needs to be clinically tested in its digital form.

References

Ally BA, Budson AE (2007) The worth of pictures: Using high density event-related potentials to understand the memorial power of pictures and the dynamics of recognition memory. NeuroImage 35(1): 378–395. Google ScholarCrossRef, Medline

Neuro-rehabilitation services are essential in reducing post-stroke impairments, enhancing independence, and improving recovery in hospital and post-discharge. However these services are therapist-dependent and resource intensive. Patients’ disengagement and boredom in stroke units are common which adversely affect functional and psychological outcomes. Novel techniques such as use of iPads™ are increasingly researched to overcome such challenges.

The aim of this review is to determine the feasibility, effectiveness, acceptability, and barriers to the use of iPads™ in stroke neuro-rehabilitation. Four databases and manual literature search were used to identify published studies using the terms “iPad”, “Stroke”, and “neuro-rehabilitation”. Studies were included in accordance with the review selection criteria. A total of 16 articles were included in the review. The majority of the studies focused on iPads use in speech and language therapy. Although of small scale, the studies highlighted that iPads are feasible, have the potential to improve rehabilitation outcomes, and can improve patient’s social isolation. Patients’ stroke severity and financial limitations are some of the barriers highlighted in this review. This review presents preliminary data supportive for the use of iPad technology in stroke neuro-rehabilitation. However, further research is needed to determine impact on rehabilitation goals acquisition, clinical efficacy, and cost-efficiency.

Uber

Uber taxis come in all shapes and sizes. You can book one at the touch of a button.

What’s more, you can specifically look for wheelchair accessible vehicles!

You don’t even need cash when you book your taxi. The service offers cashless payment, which is ideal if you’re stuck and need a little help getting home.

Tecla Access

The Tecla Access product is designed to make your smartphone or tablet completely hands-free. It’s ideal if you need to be occupied controlling your wheels, rather than controlling your phone.

Tecla is designed for mobility scooters and electric wheelchairs, and it does require the purchase of additional equipment. But, once it’s set up, you can use motions like blinking and blowing, and can also use the controls on your wheelchair or scooter, to access every feature on your usually-handheld device.

With the right app combination, you can use Tecla Access to control every aspect of your home as well. This means that it’s easy to develop a smart home that is more accessible than ever before.

FINGER MOTION

Exercises which bring feeling to your finger tips!

The new Finger Motion application was specifically developed for exercises using individual fingers and the hand on the iPad. A variety of games, which can be played with individual or multiple fingers, are available. Furthermore, in the extended version the user can carry out exercises instructed by a deviation profile to improve motion control. The user also receives individual feedback on accuracy and execution after each exercise. Follow-up evaluations give insight into the number and intensity of games passed.

One App, many Benefits

The Fingermotion App allows clinics to be closer to their patients than ever, even after completion of the patients’ therapy programme. Simply create your own page and connect with your patients. The additional offer makes your clinic unique, attracts new target groups and increases revenue!

Abstract

Background: Self-led therapy has the potential to extend rehabilitation and enhance recovery after stroke. Evolving technology can add support and structure to this approach. Our objective was to develop and evaluate the See, Imagine, Move; Upper Limb Action Therapy (SIMULATe) application; an iPad-based, cognitive and physical training intervention focused on (re)learning activities of daily living after stroke.

Method: The SIMULATe application was developed using a user-centered approach (ISO 9241-210). The therapy exploits the putative human mirror neuron system to enhance physical practice and positive affect. To evaluate SIMULATe, community dwelling stroke survivors (N=13) between 3 months and 5 years after stroke entered a single group trial. Participants accessed SIMULATe via an iPadTM and observed, imagined and physically practiced functional activities for up to 90 minutes a day for 18 consecutive days. Primary outcome measures included: adherence; retention; usability (System Usability Scale; SUS); and adverse effects. Secondary measures (pre- and post-test) included: the Action Research Arm Test (ARAT); 9 Hole Peg Test (9HPT); Grip Strength (GS); and the Positive and Negative Affect Scale (PANAS). Where appropriate, results are reported as median scores (IQR).

Conclusion: Technology-dependent, self-led therapy appears to be feasible, safe and acceptable to stroke survivors. Further development and investigation in a randomized controlled trial with a usual care comparator is warranted.

There is now an iOS App for PT Journal. An iPhone, iPad, iPod Touch will allow for easy access and online reading of the journal. If you are looking to read the articles before print, then this is the app for you!

You will need to be an APTA member or institutional member to access the journal to get full access. With an individual membership, you will need to login using an APTA membership and password. If you are on a wireless network through your institution, the app will automatically recognize your institution’s membership. If you are not on their network, a institutional proxy can be requested.

After first opening the app, you will have the option of having it send you notifications. The next step allows you to download the entire article or change the settings regarding downloading the full issue. In the setting you change set the new issue to automatically download or turn it off. You can also set the storage limit at different levels or leave it unlimited.

The bottom of the app has the following tabs: issues, online first, podcast, archives, and more. The online first section is where you will find future articles which have yet to be published in the paper version of the journal. The podcasts section also includes the Craikcasts, various speeches from symposiums, or lectures. The archives allows for searching of back issues. There is a “more” section which allows you to select your favorites or check the history of articles you have accessed.

Have no fear though, if you are not an Apple user other great Android apps also exist and can be found below.

This application allows you to search for exercises appropriate for people with spinal cord injuries and other neurological conditions. It is a very handy reference for physiotherapists and other professionals.

Over 600 exercises are available with over 1000 images.

You can search by condition, exercise type, body part, equipment available and age category.

You can can select exercises and save them to up to five different slots for future reference.

The application does not require an online connection to run. It is fully self contained.

This application is free, and we plan on including other languages soon. If you have ideas for more exercises, please contact us.

These are some of the apps that are available which may be suitable for OTs or service users. These apps are not endorsed by BAOT/COT – we aim to list as many as possible to make OTs aware of the options available. If you have used any of these apps, please do leave a comment to tell others what you thought!

The American Academy of Neurology’s acclaimed magazine for patients and caregivers is brought to you for the iPad or Android devices. Read the latest news about neurology diagnosis, treatment, and management…wherever and whenever it’s convenient for you.

Easy-to-read full-text articles that can be recommended via email Adjustable text sizing with “pinch and zoom”

Convenient “pinch and zoom” text resizing

Engaging images, figures, and tables

Background downloading allows issues to continue to download when you exit the app

Published bimonthly, Neurology Now is written especially for patients and caregivers. Articles provide in–depth perspectives and useful tips on living with and managing a wide range of neurologic disorders, including multiple sclerosis, Alzheimer’s disease, epilepsy, migraine, neuropathy, Parkinson’s disease, and stroke.

In addition, Neurology Now includes inspiring stories by patients and their caregivers, as well as advice for making informed decisions about wellness and disease prevention.

Try the apps, and give us your feedback to help us shape future versions.